Health Services Provision

Ceisteanna (156)

Eugene Murphy

Ceist:

156. Deputy Eugene Murphy asked the Minister for Health the progress that has been made in regard to the inadequacies of the diagnosis, testing and treatment of Lyme disease here since the public rallies on the issue in 2017; and if he will make a statement on the matter. [7556/18]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

Lyme disease is a bacterial infection transmitted to humans by bites from infected ticks infected. The infection is generally mild affecting only the skin but can occasionally be more severe and highly debilitating. Lyme disease is diagnosed by medical history and physical examination and can be a difficult diagnosis to make in cases which do not develop the characteristic rash. The infection is confirmed by blood tests which look for antibodies produced by an infected person's body in response to the infection. These normally take several weeks to develop and may not be present in the early stages of the disease.

Testing for Lyme disease is available in each of the HSE’s Hospital Groups, who have a number of Infectious Disease Consultants who are expert in the diagnosis and management of the disease. Laboratories in Ireland generally follow the laboratory testing recommendations of the US Centres for Disease Control and Prevention, the Infectious Disease Society of America, the European Federation of Neurological Societies, and the British Infection Association. Irish laboratories have their own quality assurance methods to make sure the tests are working correctly as well as being accredited by the Irish National Accreditation Body to perform the test correctly. In undertaking Lyme testing, it is essential that the results are interpreted in the light of the clinical condition of the patient. If the result of this initial screen is equivocal, the patient's samples are referred to the U.K.'s Rare and Imported Pathogens Laboratory. This laboratory uses a two-tier system recommended by American and European authorities which involves a screening test followed by a confirmatory test. Testing which is performed abroad may be performed in laboratories which have not met National or International Accreditation (Quality Standards) and these tests may be more likely to give a “false positive” result.

Lyme disease can be very successfully treated using common antibiotics by General Practitioners. In Ireland, treatment by most clinicians is based on that laid out in evidence-based guidelines published by the Infectious Diseases Society of America (IDSA) in 2006. Antibiotics are effective at clearing the rash and helping to prevent the development of complications, and are generally given for up to three weeks. If complications develop, intravenous antibiotics may be considered.

As accredited testing and treatment are readily available in Ireland, there is no need for anyone to travel abroad for diagnosis or treatment.

Emergency Departments

Ceisteanna (157)

Thomas P. Broughan

Ceist:

157. Deputy Thomas P. Broughan asked the Minister for Health the plans, timeframe and financing of the new accident and emergency department at Beaumont Hospital, Dublin 9; and if he will make a statement on the matter. [7558/18]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

As the Health Service Executive is responsible for the delivery of health care capital projects, my Department has requested the Health Service Executive to reply directly to you in relation to your questions regarding the emergency department capital development at Beaumont Hospital.

Gender Recognition

Ceisteanna (158, 188, 189)

Joan Burton

Ceist:

158. Deputy Joan Burton asked the Minister for Health if his Department has prepared written guidelines for staff and the public on dealing with transgender matters; if they are published; if staff have received training in respect of this; if his Department is participating in or making a submission regarding the review being undertaken in respect of the operation of the Gender Recognition Act 2015; and if he will make a statement on the matter. [7571/18]

Amharc ar fhreagra

John Lahart

Ceist:

188. Deputy John Lahart asked the Minister for Health the requirements surrounding the availability of hormone replacement therapy in regard to transgender health care here; if his attention has been drawn to the lack of physicians willing to prescribe hormone replacement therapy; and if he will make a statement on the matter. [7695/18]

Amharc ar fhreagra

John Lahart

Ceist:

189. Deputy John Lahart asked the Minister for Health the number of persons waiting to see physicians regarding hormone replacement therapy; the number of physicians treating persons through hormone replacement therapy; and if he will make a statement on the matter. [7696/18]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

I propose to take Questions Nos. 158, 188 and 189 together.

Transgender-specific guidelines have been developed by WPATH (World Professional Association for Transgender Health) and the Endocrine Society (who updated their guidelines in 2017). These guidelines were devised by experts in transgender healthcare, along with members of the International Transgender, Transsexual and LGBT community, and supported by the Transgender Equality Network of Ireland (TENI).

The guidelines recommend a comprehensive multidisciplinary psychosocial assessment prior to commencement of hormone therapy by endocrinology services. The assessment focuses on more than just assessment for the possible diagnosis of Gender Dysphoria. The guidelines highlight several criteria which must be met prior to referral for hormonal intervention. It is important that co-morbid conditions are identified and addressed, and that people access the supports that they need to manage co-morbid difficulties, which can impact on response to medical transition (including hormone treatment).

International best practice involves an assessment by a multi-disciplinary team and shared decision making in the best interests of the individual. Both WPATH and the Endocrine Society Guidelines 2017 specify the assessment must be carried out by a mental health professional (s) with experience in transgender healthcare and possess specific skills. Endocrinologists and General Practitioners (GPs) do not possess these skills, and require access to the multidisciplinary team as described. GPs would only see a small number of gender variant individuals during their lifetime in clinical practice, and would not be in a position to build up the requisite skillset outlined in WPATH and Endocrine Society Guidelines or have the time resource to conduct a comprehensive evaluation.

Informed consent is essential, whereby benefits and risks of hormone treatment and surgery are discussed with individuals seeking these interventions. Although regret rates are low, it can happen and can also lead to high levels of psychological distress. Healthcare providers work with people to try to prevent negative outcomes. The emerging evidence on good outcomes following medical and/or surgical transitioning is based on use of multi-disciplinary psychosocial assessment, fulfilment of criteria for hormones and on-going psychological support throughout the process. It is important that psychological support is available to individuals before, during and after transitioning.

Prescription of hormone blockers and cross-sex hormones for transgender people is relatively new. Significant side effects can occur with cross sex hormones including irreversible physical changes and infertility. There is a lack of long-term research on outcomes. For these reasons the decision to prescribe should only be made by specialists (i.e. Endocrinologists) in consultation with other professionals involved in the assessment process. Shared decision-making is in accordance with best practice internationally. Prescriptions can then be supported by local GPs with specialist guidance.

The Best Practice approach as outlined above is endorsed in the Service Development Model as developed by the Quality Improvement Division of the HSE in 2017, in collaboration with TENI. This model is providing the framework for the development of National Gender Clinics and MDTs for children and adults, funded by the Acute Hospitals and Mental Health Divisions of the HSE. Recruitment will commence to develop these national teams in 2018. This investment in new posts in 2018 which includes one consultant endocrinologist (adult services), one consultant endocrinologist (paediatric services), one social worker (adult services), one speech and language therapist (adult services), one senior psychologist (adult services), one senior psychologist (paediatric services), one clinical nurse specialist (Paediatric services), two administrative support officers (adult and paediatric services) is a concerted measure by the HSE to address the waiting times and immediate service needs of children, adolescents and adults in transition. The HSE, across a number of programmes including mental health, acute hospitals, primary care and social inclusion, is committed to building services for this community in accordance with International Best Practice.

The HSE is a member of the group established to review the operation of the Gender Recognition Act, and the Department has no plans to make a submission to the review group. The number of persons waiting to see physicians regarding hormone replacements therapy and the number of physicians treating persons for hormone replacement therapy are service matters. I have referred these issues to the HSE for direct reply to the Deputy.

Occupational Therapy Provision

Ceisteanna (159)

Éamon Ó Cuív

Ceist:

159. Deputy Éamon Ó Cuív asked the Minister for Health the reason a person (details supplied) has not been provided with occupational therapy in view of the fact that the person's parents receive the domiciliary care allowance; his plans regarding early interventions for children; and if he will make a statement on the matter. [7584/18]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

The Government is committed to providing services and supports for people with disabilities which will empower them to live independent lives, provide greater independence in accessing the services they choose, and enhance their ability to tailor the supports required to meet their needs and plan their lives. This commitment is outlined in the Programme for Partnership Government, which is guided by two principles: equality of opportunity and improving the quality of life for people with disabilities.

As the Deputy's question relates to an individual case, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply to the Deputy.

Cancer Services Provision

Ceisteanna (160)

Eugene Murphy

Ceist:

160. Deputy Eugene Murphy asked the Minister for Health if proposals by a person (details supplied) to develop a radiation oncology department at Midlands Regional Hospital, Tullamore, will be considered; and if he will make a statement on the matter. [7596/18]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

The provision of radiation oncology services in Ireland is governed by the National Plan for Radiation Oncology. The National Plan set out the projected infrastructure and equipment required to meet the needs for radiation oncology over a 20 year period.

Radiation oncology is available in five public hospitals: St. James's Hospital, Beaumont Hospital, St. Luke's Hospital Rathgar (which three together form the St. Luke's Radiation Oncology Network, Dublin), Cork University Hospital and University Hospital Galway. Radiation oncology services for public patients are also provided in two private facilities in Waterford and Limerick under the aegis of Cork University Hospital and University Hospital Galway respectively. Meanwhile, patients from the North West can receive radiation oncology treatment at the North West Cancer Centre in Altnagelvin Area Hospital, Derry.

The model of care for radiation oncology allows for the sufficient volume and concentration of activity and expertise to facilitate high quality radiation oncology treatments in line with best evidence and international best practice. Modern radiation oncology is increasingly complex. Delivery of such complex care requires several key components to ensure safe, high quality radiation therapy. These include appropriate physical infrastructure and equipment to meet the needs of both patients and staff, a highly trained multidisciplinary team including specialist doctors, nurses, radiation therapists, physicists and other health and social care professionals and a system of quality assurance that can ensure that radiation oncology services are safe, effective, equitable, efficient, timely and centred on the patients needs.

Future planned developments for radiation oncology services include the construction of new and upgraded facilities in Galway and Cork and the expansion of the facility in Beaumont. In line with the National Cancer Strategy 2017-2026 and the National Plan for Radiation Oncology, it is not intended to establish a centre for radiation oncology in the Midlands Regional Hospital, Tullamore.

Mental Health Services

Ceisteanna (161)

Tom Neville

Ceist:

161. Deputy Tom Neville asked the Minister for Health the status of regulations to designate counsellors and psychotherapists as professionals; and if he will make a statement on the matter. [7602/18]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

The draft regulations to designate the professions of counsellor and psychotherapist under the Health and Social Care Professionals Act 2005 and to establish a registration board for the professions have, in accordance with the provisions of the Act, been laid before each House of the Oireachtas. Resolutions approving the drafts have been submitted to each House for consideration. I expect that the Houses will consider the resolutions in the coming weeks.

Primary Care Centres Provision

Ceisteanna (162)

Patrick O'Donovan

Ceist:

162. Deputy Patrick O'Donovan asked the Minister for Health the status of the provision of a primary medical centre (details supplied) in County Limerick; the number of expressions of interest that have been received by the HSE for the provision of this centre; and the current position with the application process. [7607/18]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

As the HSE has responsibility for the provision, along with the maintenance and operation of Primary Care centres and other Primary Care facilities, the Executive has been asked to reply directly to the Deputy.

Legislative Programme

Ceisteanna (163, 190, 202)

Catherine Connolly

Ceist:

163. Deputy Catherine Connolly asked the Minister for Health when Parts 2 and 3 of the Children and Family Relationships Act 2015 will be commenced; the reason for the delay in enactment; and if he will make a statement on the matter. [7609/18]

Amharc ar fhreagra

Ruth Coppinger

Ceist:

190. Deputy Ruth Coppinger asked the Minister for Health when he plans to commence Parts 3 and 4 of the Children and Family Relationships Act 2015; and if he will make a statement on the matter. [7697/18]

Amharc ar fhreagra

John Curran

Ceist:

202. Deputy John Curran asked the Minister for Health when he plans to commence Parts 2 and 3 of the Children and Family Relationships Act 2015; and if he will make a statement on the matter. [7778/18]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

I propose to take Questions Nos. 163, 190 and 202 together.

Officials in my Department are undertaking the work necessary to facilitate the commencement of Parts 2 & 3, including Sections 20 - 23, of the Children and Family Relationships Act 2015. We are working to resolve a small number of technical issues in order to ensure that the processes associated with Parts 2 & 3 of the Act can be commenced. I hope to be in a position to lay the Regulations before the Houses of the Oireachtas as early as possible in 2018.